Making a Difference

The overall involvement in our Folding@Home project was significant in that we were ranked 2^nd in our total grid team contribution. During our service, our team number was contributing processing power to the research of protein misfolding.

The program allows for protein coding to be simulated in milliseconds over a long time frame in order to better understand the entire time frame of disease or mutation's development. Another aspect of study run by these programs is the similarities in viral adhesion to cells having similar identifying carbohydrate markers. This knowledge will lend to a better understanding of how viruses and diseases transfer from species to species, and why they vary in severity between species. This information could potentially lead to finding more answers to questions concerning the diagnosis and mutation of plaques during the onset of Alzheimer’s disease.

Overall, our group processed over 50 million work units and contributed to our team score with a total score of 18 billion. (Points are determined by the performance of a each contributor's folding hardware (CPU, GPU, etc.) relative to a reference benchmark machine). Also, we've decided that we will continue to run this program in order to contribute to further research.

Although we know Alzheimer’s disease involves progressive brain cell malfunction, we have not yet identified any single reason why these cells fail.

1) What is the approximate h² (value of heritability) of Alzheimer’s disease?

There is no official known cause of Alzheimer’s disease but many hypotheses are being based on research done in the past ten years. Especially twin studies have shown that the disease is most likely highly heritable:

In 2006, a study was done to determine patterns of Alzheimer’s in twins. They found it was more common for identical twins to both have Alzheimer's compared to non-identical twins. The researchers used a statistical analysis of risk rates within the groups in order to establish an estimate of how significant genetic factors are. They estimated heritability for Alzheimer's to be between 58% and 79%. Also, there was an average of 3.66 years difference in age at onset of the disease between 25 sets of identical twins, and 8.12 years difference between 20 sets of fraternal twins. This data suggests that genes had a role in determining when Alzheimer's was seen. *

At this time, only one gene, apolipoprotein E (ApoE) has been positively linked to late-onset Alzheimer's disease. However, only a small percentage of people carry the form of ApoE that increases the risk of Alzheimer's. Other genes or combinations of genes may be involved that we are still unaware of.**

Other research has shown that those who have a parent, brother or sister, or child with Alzheimer’s are more likely to develop Alzheimer’s. Also, the risk has been shown to increase if more than one family member has the illness. When diseases are likely to run in families, either heredity or environmental factors or both may play a role; but as stated above with Alzheimer’s disease this yet to be determined. ***

2) What environmental factor(s) influence Alzheimer’s disease?

Researchers have also explored several environmental factors that may play a role in Alzheimer’s disease or that activate the disease process in people who have a genetic vulnerability. Some studies have suggested a connection between severe head injuries in early adulthood and Alzheimer’s development. Lower educational level, which may decrease mental and activity and neuron stimulation, has also been investigated as an environmental factor. Although it has been hypothesized that infections, metals, or industrial toxins may trigger oxidation, inflammation and the disease process, thus far, there does not appear to be any conclusive evidence, that they cause Alzheimer’s disease.**

Thought to be risk factors that we can influence:

Head injuries: There appears to be a strong correlation between serious head injury and future risk of Alzheimer’s. Protect your head by buckling your seat belt, wearing your helmet when participating in sports.

Heart-head connection: There is strong evidence that links brain health to heart health. Every heartbeat pumps about 20 to 25 percent of your blood to your head, where brain cells use at least 20 percent of the food and oxygen your blood carries. The danger of developing Alzheimer’s or vascular dementia seems to increase with many conditions that damage the heart or blood vessels. These conditions include high blood pressure, heart disease, stroke, diabetes and high cholesterol. Work with your doctor to monitor your heart health and treat any problems that may occur.

General healthy aging: Other evidence suggests that strategies for overall healthy aging may help maintain a healthy brain and, in turn, even offer some defense against developing Alzheimer’s or related diseases. Try to keep your weight within recommended guidelines, avoid tobacco and excess alcohol, stay socially connected, and exercise both your body and mind***

sources referred to:

* http://news.bbc.co.uk/2/hi/health/4686806.stm and http://www.medpagetoday.com/Neurology/AlzheimersDisease/2633

** http://health.nytimes.com/health/guides/disease/alzheimers-disease/causes.html

***www.alz.org

Case Study Questions: Fatal Familial Insomnia and How It Relates to Alzheimer's Disease

1. Based on your research into Alzheimer’s disease and your interview, how are these two disorders alike?

Fatal familial insomnia (FFI) is a genetic disorder. We are still not completely sure about the cause of Alzheimer’s disease but it is likely that genetics plays a large role in causing early-onset Alzheimer’s. Both diseases usually occur in an individual’s later stages of life (The average age of the onset of FFI is 49 and the average age of an Alzheimer’s patient is 65+).

Over time FFI degenerates the thalamus of the brain. Alzheimer’s also decays parts of the brain but is not specific to the thalamus, in fact, it can spread through the entire brain as it progresses. Because of this the progression of the disease can affect several functions of the brain. Likewise, as FFI progresses its symptoms are directly related to the malfunction of the responsibilities of the thalamus.

Plaques are abnormal structures that responsible for damaging nerve cells. These structures are found in an Alzheimer’s patient’s brain and are a result of FFI disease.

Also both diseases develop in stages. Alzheimer’s involves an abnormal aging of the brain and moves through 7 stages, and FFI involves the affects of a mutated protein and moves through 4 main stages

Alzheimer’s disease is a widespread form of dementia. As FFI progresses, following insomnia other common symptoms include poor reflexes and dementia. Both diseases lead into other serious problems as they progress; eventually leading to death. Also, no cure has been found for either disease.

2. What are prions?

A prion is a pathogen or disease-causing agent that contains no genetic material. It is a protein that is usually normal and harmless, but by folding into an unusual shape, the normal prion turns into a harmful agent. It then invites other normal prions to become harmful. This infectious protein particle is like a virus but lacks a nucleic acid (DNA/RNA). Prions have been held responsible for a number of degenerative brain diseases. Prion diseases have both infectious and hereditary components. The gene that codes for prions can mutate and be passed on to the next generation.

Here’s a video that shows how prions are made.

3. FFI is an autosomal dominant disease, meaning that if an individual inherits just one dominant allele from either parent, they will develop the disease. However, this disease does not manifest itself phenotypically until after reproductive age. So can this disorder be acted on by natural selection? What about Alzheimer’s? What is maintaining these disorders in the population?

Genes can be activated at any point during a human’s life time. This is why we see the development of diseases such as cancer and other degenerative diseases. Natural selection will never get rid of this disease due to its dominate expression. As long as those who hold the gene are able to reproduce it will constantly be maintain in a specific population. Unless the disease is cured it will maintain at a consistent level in populations. Since the direct mechanism of Alzheimer’s is unknown it is hard to predict whether it will rise in frequency or decline. However since both of these disorders result in malformation of proteins and the aggregation of plaques it can be inferred that they may share similar genetic pathways.

4. FFI is caused by a single mutation that, in the presence of methionine at amino acid position 129, changes aspartic acid to asparagine. This same mutation, in the presence of valine at position 129, causes a separate prion-disease called Creutzfeldt-Jacob syndrome. In cattle, the homologous syndrome is Mad Cow disease. How can studying protein folding and miss-folding help in understanding diseases like these?

These missfoldings of proteins are the result of single mutations in amino acids. Since the structure of a protein is determined by such specific encoding the potential knowledge for protein manipulation and correction is nearly endless. The study of similar diseases in lower vertebrates could also help us understand the evolution and early stages of homologous genetic mutations. This knowledge could provide new technology to eliminate genetic defects and degenerative diseases. The fact that a single position in the chain can mutate to cause two separate diseases also demonstrates the diversity of the genetic code. If one position can code for multiple protein malformation, it is possible many similar pathologies could be linked on a single mutation point with separate amino acids.

With further research, we could see if other neurodegenerative diseases, like Alzheimer ’s disease, are caused by missfolding proteins. By identifying a common cause they might be able to figure out a cure to not just one neurodegenerative disease, but hopefully all prion related diseases. The ability to suppress the missfolding of these proteins could lead to a delay or loss of symptoms, which would allow patients to stabilize the disease, making it possible to live longer.

5. This disease was discussed last week on Medical Mysteries: The two sisters in this story lost their mother to FFI. One sister chose to be tested for the mutation, while the other sister did not. Would each of you want to know whether or not you had a disease such as this, or would you rather remain unaware?

I would definitely want to know if I had a disease like this so I could at least make my family aware of it too so they would not have to go through the process of wondering what is causing the problems that a disease like this can cause. Plus, if I had children I would want them to be prepared for something like this, that way it can go a little bit smoother for everyone involved. If you are aware of a disease like FFI before the onset of symptoms you could raise awareness and hopefully find a cure so your children do not have to suffer as well. (Margaret Cameron)

I would not bother being tested for this disease because I would not enjoy that hanging over my life. I choose to live everyday a new and know something like that would only create fear and dread. That is no way to live and I think one should just live the time they have and enjoy because it ends no matter what. (Price Heins)

I would probably choose to be tested for the mutation. Although the symptoms and end result of the disease are depressing, I would still want to know if I had the disease. The fact that the disease is in my genetics would be on my mind all the time and I would worry about it my whole life. Having that information would make me feel more aware and I could prepare myself and my family for what would be coming in the future. (Kristine Makhamreh)

6. The NCBI link above, under “Animal Model”, discusses a phenotype in mice that is similar to that of FFI in humans. Why, from an evolutionary standpoint, might it be informative for scientists or doctors to study conditions in mice when investigating human diseases like FFI?

Mice are easy a specimen to study because they are small, reproduce quickly and their life spans are relatively short in comparison to humans. Also, the moral dilemmas that doctors face when trying to work on a disease that affects the brain is much less applicable when dealing with mice. If the mice develop a similar disease this provides vital information on the origins of a degenerative disease that could have been passed on between species over the generations. In theory if another mutation occurs that leads to a new strain of a particular disease, researchers can go back and see where the strain changed during its lifetime. Since many of the same genes code for the same proteins, limbs, etc, all similar genetic mutations can be compared across species. Since it is the expression, timing, and environmental factors that have a direct affect on gene expression; the more we know about how the genes evolved over time the more can be understood about genetic coding. Eventually it might lead to the testing of potential cures for the disease.

Alzheimer’s and Evolution

When considering the evolutionary consequences of Alzheimer’s disease it would be vital to know the exact age of the disease and how long it has shown prevalence among our species. Also noting the genetic factors, if any,that may link the disease prevalence to specific genotypes would provide information useful to the treatment of the disease. Understanding the consequences of environmental factors that contribute to disease development could also provide valuable data on developmental patterns and associations. If a mutation could be found that was linked to Alzheimer’s development, treatment could be done through the use of gene therapy. Finally, interpreting the development of the brain may also provide useful insight into discovering the chemical contribution to the progression of the disease.

Since Alzheimer’s effects the elderly it could be assumed that a change in brain chemistry is to blame for the disease development. The effect of protein miscoding in the brain causes the symptom of memory loss which can slowly progress until death. If we understood how this mechanism evolved we could better treat and screen for the development of Alzheimer’s disease in patients. The effects of the disease are crippling to personal function and individuality. Because of the extremely personal situation involved in the development of this ailment, more information and statistics on diagnosis rates should be available to the public.

Why would it be important for a doctor, a nurse like Kathy, or someone in Susan's position to know about evolution?
It is important for someone in the medical field to know about evolution because evolution is the basic foundation through which we understand biology. Biology is the study of life and all things related, including medicine. To have a really strong understanding of medicine you have to know how that medicine has evolved over the years. A nurse would benefit from understanding why a drug worked or did not work, and know what the particular drug was tested for and what it is actually is used for. Evolution is also important to considered when thinking about how a bacteria has evolved over the years to form a resistances to a certain medicine. Knowing that mutation and natural selection has allowed this bacteria to form a resistance will help in understanding how to create another medicine.

Interview with Susan Makhamreh

Susan Makhamreh is nursing home administrator and owner. She has been working in nursing homes almost her entire career, and she has several residents that deal with all different stages of Alzheimer's disease.

Why did you choose to work in the healthcare field?

I originally attended nursing school after high school, but didn't believe it was the right field for me. Then, I went into business and accounting, but again 10 years later I fell back into health care as an opportunity for a family business. I found out that with age comes maturity and patience and that prepared me to appreciate the field that I am in where I know every day I make a difference in my residents lives.

How often to you encounter a patient with Alzheimer’s disease?

I work in a nursing home with an average of 100 residents; of that about 70 percent have dementia. Alzheimer’s disease accounts for about half of all the dementia diagnosed residents we care for. I personally oversee their care on a daily basis.

Can you think of any interesting stories involving a patient?

Everyday there are stories that leave an impression on me. Many in which I am able to see a glimpse of my residents acting normal and lucid. One recent story involves a 89 year old female living with moderate stages of Alzheimer’s disease. She is not ambulatory but she requires total assist with all her needs. She has only been with us for about a month now and we have not heard any verbal responses from her. She is very quiet, and appears depressed. She was in the dining room in her Geri chair waiting to be fed, and I walked by her (as I always do around lunch time) and said “Good afternoon.” Then, to my pleasant surprise she replied in a very sweet, quiet voice, “Good afternoon will you give me a cup of milk.” I was amazed to hear her voice, and happy to hear that she was in better spirits that day.

Another of my favorite stories is about a resident that was a nun. She stayed with us for quite some time and she also had Alzheimer’s disease. Her language was often random, loud, and vulgar. One afternoon while her sister was visiting her, she was using this offensive language (which was characteristic of her by now) and her sister was mortified by it. She said, “You cannot be saying things like that, surely you will go to hell for being a nun and using the Lord’s name in vain.” The little old woman smiled at her and simply said, “It’s okay, God knows who I am.” We were all taken aback, especially her sister. Then she continued to say, “and anyway, I am taking you with me wherever I go.” We all laughed about how honest and sure she was in her words and her sister stopped making comments about her language.

What misconceptions exist about Alzheimer’s disease?

Many misconceptions exits about Alzheimer's disease. One main one that I have experienced is that some families believe that their loved one is just acting like a child and can control their behaviors; because of the person’s ability to remember and recall long term memories. This of course is not true, because short term and long term memories are totally separate things, and Alzheimer’s patients lose control of their behaviors. Educating families about the diagnosis is very important in order to provide them with the knowledge they need in order to cope with and understand what their loved one is going through.

How would you respond to common Alzheimer’s issues like confusion, sudden bad temper, or attempts to leave the house?

Maintaining a daily routine gives the resident a sense of security and in keeping things simple you are able to minimize confusion. First and for most the care giver must stay calm and patient while listening to the patients needs and redirecting them. You can combat bad temper and aggressive behavior by simply staying calm, not arguing, not asking too many questions, and giving the patient no more than two choices. As the care giver, you have to allow the resident to calm down since most aggressive behavior is abrupt and usually related to the resident’s environment. You must have a gentle touch and be able to know enough about your resident to redirect them by engaging them in conversation or a subject that you know they can relate to. As far as wandering, again, you have to provide a safe environment by using bars on windows or alarms on doors, and redirect them calmly. Usually Alzheimer's patients are not trying to elope they are simply walking aimlessly about, therefore, calmly redirecting them will avoid an aggressive confrontation.

For the patients with Alzheimer’s disease, how aware are they of their condition? Does their awareness come and go?

An Alzheimer's patient’s awareness can vary and come and go. I have cared for several of them and a good majority has had times of awareness, although this time is very short. As their awareness comes and goes, it is has not been in their mind long enough to know if they are aware of their condition or not. For example, we have a 78 year old resident with Alzheimer’s that has to be assisted with feeding and usually refuses to eat most meals. She has to be encouraged one sip at a time, and one day as I was assisting her she stopped, looked at me, and said that she knew how she was supposed to eat and that she can only eat so much. This is a resident that has never been heard completing any one cohesive sentence. Again, her awareness was only for the moment.

Does the emotional state of a patient with Alzheimer's have any effect on the progression of the disease on an individual basis?

Yes, I think the emotional state does effect the progression of the disease. Residents that are more emotionally stable seem to stay at the same level of functioning without a quick worsening in progression. Emotional distressed and depressed patients can cause physical medical complications (by refusing to eat or get out of bed). You have to provide Alzheimer's patients with a calm environment as best as you can. Alzheimer's disease is known for abrupt mood changes and emotional changes, but if you are able to maintain a calm approach with safe environment you will be more successful at maintaining the stability of patients.

Other than memory loss, what part of one’s individuality is most affected by the progression of the disease? Is there a certain point in which ones identity is lost?

As the disease progresses, individuals can experience changes in personality and behaviors. Families usually tell us that this is opposite of who their loved once was. For example, a house wife and mother who was the patient and calm rock of her family, now yells and screams for everything. Of course, this example shows one extreme. Every resident struggling with Alzheimer’s disease has their own personal progression of the disease and its effects on their life. Sometimes keeping an object with them that reminds them of a positive aspect of their life before the disease can help them feel more like they are fully maintaining their identity.

Does Alzheimer's seem to be more prevalent in a certain race, sex, or ethnic background? If so, could there possibly be a genetic link to the transference of the disease through generations?

Alzheimer's seems to be more prevalent in females as far as my own experience with nursing home patients. (But that could be attributed to the higher longevity of women compared to men.) Without more research, we cannot really be sure if there is any real ethnic, genetic, or environmental prevalence or influence on Alzheimer’s disease.

How important is the search for a cure for Alzheimer's disease?

Research being done to find a cure for Alzheimer's disease is crucial. I am optimistic that a cure will be found. We need to devote the necessary funds to back up our researchers. This disease, unlike any other, affects the physical, mental, emotional, and psychosocial aspects of each individual diagnosed. Since it attacks the brain cells, it is the hard to find a cure. Researching the human brain is limited, and available research shows that changes in the brain begin 10 to 20 years before any visible physical signs are detected. All of these things make research challenging, but as the population ages the search for a cure becomes more and more important.

Is there any other personal insight relating to the disease that you would like to add or discuss?

To sum up some thoughts: The number of Alzheimer's disease patients doubles every five years. It affects people between ages 65 to 85. As baby boomers are aging, and since they are the largest aging population, they especially will have to face this disease in the next 10 to 15 years. If we are unable to find a cure, we will have to be ready to provide the care that is needed. Alzheimer's can affect anyone regardless of gender or ethnicity. Every generation seems to be more independent than the proceeding generation. We have to embrace these facts, and educate ourselves to provide the necessary care and resources in order to avoid neglect and misjudgment of the disease.

Interview with Kathy Naufel R.N.

Kathy Naufel is a registered nurse who has worked in several nursing homes/ senior care facilities as the director of nursing and charge nurse. She is very experienced with caring for patients with the diagnosis of Alzheimer's disease.

Why did you choose to work in the healthcare field?

I choose to work in the healthcare field so that I could have a direct impact on society. In my eyes I am doing something that actually impacts people on a very personal level; it is very rewarding work.

How often to you encounter a patient with Alzheimer’s disease?

I encounter patients with Alzheimer's disease, unfortunately, more often than one would want. 70-80% of my patient's have a diagnosis of Alzheimer's of Dementia.

Can you think of any interesting stories involving one of those patients?

There are many interesting stories; one that stands out in my mind is about a patient who is a retired nurse. She is probably in the 6th stage of Alzheimer’s, she is at the point where she still responds to her name but has forgotten the routines of daily living, like brushing teeth, combing hair, using the bathroom etc. She is one that unfortunately still has moments of lucidness every now and then; you can see the shame she feels when she realizes that she is in a nursing home unable to care for herself and unable to explain what is happening to her. Unfortunately in our society our geriatric population feels that shame, they view themselves not as a sick person with a disease but as less of a person who is losing their mind which can be heartbreaking to watch. This particular patient actually lights up at times and often goes up to the medicine cart and wants to take care of other patients on her unit. She calls them her patients and at times she actually will catch things that our staff may miss. One time she was in the dining area and she saw a patient clutching her chest, she yelled out for someone to get help, and said “call 911 Ethel is having a heart attack!”. And she was right. Later when she was asked how did knew to call for help, she simply said "she was cyanotic and clutching her chest". But sadly two seconds later she couldn't remember where her room was, or what is she was suppose to be doing. This is a very cruel disease.

How important is the search for a cure for Alzheimer's disease?

A search for a cure is pivotal for our aging population. Finding a cure can mean so many things for this population: a better quality of life, a healthier long-living body, and (most importantly)the ability to live, age, and die with dignity and the ability to experience as much as possible in life.

What do you think about using grid computing in this search?

I think grid computing may have a great impact on finding diagnostic implications and genetic ties to Alzheimer's, but I don't think that it would have much impact on actual implication of practice for interventions for everyday problems that this disease presents. While Alzheimer’s is a defined disease process, it effects every individual differently and it would be hard to compile information that may fit and categorize people, every patient is a unique individual with very specific habits and needs.

What misconceptions exist about Alzheimer’s disease?

One misconception is that a patient with a below average intelligence level is at a higher risk for developing Alzheimer’s. While research shows that keeping the mind engaged and stimulated may lesson your chances of developing Alzheimer's, there is just as much research that shows that the your genetic disposition has a much bigger impact and can contain triggers for developing the disease. We have had a president that died of Alzheimer’s, in my career I have had patients that worked as doctors, lawyers, accountants, and CEO's; this disease doesn't discriminate.

Another miss-conception is that this very fragile population is crazy. Unfortunately when patients enter the healthcare system many get miss-diagnosed with things other than Alzheimer’s (like psychiatric disorders, explosive behavior disorders, or major depression). All of these may accompany a diagnosis of Alzheimer’s but many in the healthcare field see a psyche diagnosis and do not look beyond it, so these patients end up on psyche medications that may actually advance the disease process. In the end this hurts this population by delaying effective proper treatment and interventions.

Also, some family members have a hard time understanding the disease so when a loved one doesn't remember them or lashes out they take it personally, and do not see it as a disease process like they might if they had a cancer diagnosis.

Is the progression of the disease variable in independent patients? (Meaning can it progress very rapidly in some and slower in others. ) Could there be genetic factors that affect this?

I think the progression of the disease is different in each individual, which could have some genetic influence. There are 7 stages to Alzheimer’s and each individual is unique. I have seen some go from stage 3 to stage 6 in a month’s time (not years). On the same the opposite end of the spectrum, I have seen some stay in stage 4 or 5 for several more years than expected. There may be a genetic factor that affects this.

What are the classifications for the levels of severity of the disease in individuals?

There are 7 stages; the classifications we use are based on the stage and level of functioning. Stages 1-4 fall under level one because most patients can still function in society with help from family and the community. Stages 4-5 require 24 hour supervision because there is a moderate to severe cognitive impairment and the individual needs help usually with all or most of activities involved in daily life. Level 3 is usually stages 6-7 which are severe cognitive end stages of the disease.

These levels help us in identifying the interventions used for a specific group and the appropriate activity level needed for cognitive stimulation.

Most of the medications for Alzheimer’s disease are still being researched, in your experience are there any medications that you feel are the most helpful(or harmful) or does it vary from patient to patient.?

There has been an increase in research for new medicines, but I have not had a more positive or negative experience with one particular medication over another. Usually it is a combination of meds like Aricept and Nemanda. If given early enough, I have seen the disease process actually slowing down. Yet, most patients sadly don't get diagnosed in the first or second stage thereby limiting how much impact pharmaceuticals can deliver.

As the population of older individuals increases, do think that if a cure or ways of prevention of Alzheimer’s disease has not been found, that it will reach epidemic proportions among the elderly?

There is a lot of speculation about this disease in the future; many say that with the baby boomers we will see a large increase of the Alzheimer’s population. I think an epidemic is very possible because we are going to have an increased incidence of aging population period which will mark an increased incidence of Alzheimer’s.

Is there any other personal insight relating to the disease that you would like to add or discuss?

My experience with Alzheimer’s patients has opened my eyes to living my life to the fullest and not taking for granted the gift of our mind. I have seen many families struggle with loved ones and their Alzheimer's diagnosis. I think most of them blame themselves somehow for not noticing earlier or just feel guiltily for having to keep them in a nursing home. I think we need to put more money towards educating the public about early signs of the disease so that we can diagnose patients earlier, and hopefully get them started earlier on medications sooner. That may slow down the progression of the disease which can dramatically improve their quality of life.

Focus: The Brain

As we grow older, so does our brain. Normally an elderly person would experience an occasional difficulty recalling things and slowed thinking as they aged. Alzheimer's disease causes abnormal effects of aging on the brain. Severe memory loss, confusion and physical changes lead to the conclusion that brain cells are dying.

The progressive stages of Alzheimer's include:
Stage 1: no impairment- normal function with no memory problems evident
Stage 2: very mild cognitive decline- patient feels as if they are sometimes forgetting small everyday things
Stage 3: mild cognitive decline- can be diagnosed in some patients, family and peers begin to notice changes
Stage 4: moderate cognitive decline- reduced memory of personal history and ability to accomplish complex physical and mental tasks, decreased awareness of recent occasions/events
Stage 5: moderately severe cognitive decline- confusion increases and major gaps in memory become evident
Stage 6: severe cognitive decline-forget names of familiar faces, imperfect memory of personal history, may require assistance with eating and using the restroom, personality changes, tend to wander or become lost
Stage 7: very severe cognitive decline- patient loses the ability to respond to their environment, speech problems, loss of ability to walk/sit, eat/swallow, or use the restroom without assistance, muscle reflexes are abnormal
(The duration of the entire disease process can range from 3 to 20 years.)
Parts of the brain function and interact through the networking of nerve cells. Each section serves a particular purpose, and as the progession of Alzheimer's disease spreads throughout the brain it effects several of its functions.
Plaques and tangles are abnormal structures found in the brain of an individual with Alzheimer's disease. These structures are responsible for destroying and damaging nerve cells. Plaques build up between the cells and tangles are twisted fibers of protien that grow inside dying cells. An Alzheimer's patient devlopes many more of these structures than normal as they age, therefore causing the disease to spread throughout thier brain (see video).**

**information found at www.alz.org